Background: Malaria, earlier considered rare in neonates, has been reported with increasing frequency in the last decade. Neonatal malaria diagnosis is challenging because the clinical features are non-specific, variable and also overlap with bacterial infection. Aim: To determine the prevalence of neonatal malaria and the associated clinical features in newborn babies with fever. Patients and methods: One hundred and fifty neonates with fever admitted into the Newborn unit of the University of Calabar Teaching Hospital, over a six month period, were recruited consecutively. Symptoms and signs for each neonate were documented. Blood film for malaria parasites and investigation for sepsis workup were done before commencement of drugs. Results: One hundred and fifty babies were recruited. Most (85.3%) of the babies were aged ≤7 days. One hundred and thirty six (90.7%) of the mothers were booked for antenatal care (ANC). Most of the babies were from primiparous women (54.7%). Six babies (4%) had malaria parasitaemia with four (2.7%) being congenital malaria and two (1.3%) acquired malaria. Plasmodium falciparum was the only species identified. All six with malaria were from the 136 booked mothers. Four of the affected six neonates also had septicaemia. The clinical features in babies with malaria only were, fever, fast breathing and jaundice while those with malaria and bacterial co-infection had, in addition, poor suck. Conclusion: Malaria infection and septicemia can coexist in some Nigerian newborns and since the clinical presentation of each of these condition are closely similar, it is recommend that malaria parasite investigation be included as part of the investigation in the newborns with fever. This approach can help to avoid a delay in applying the appropriate therapeutic intervention

Introduction: Neonatal sepsis is an important cause of morbidity and mortality in developing countries.Early diagnosis and treatment is necessary in order to mitigate this trend.Procalcitonin is one of the acute phase reactants meant for this purpose.The objective of the study was to determine the usefulness of procalcitonin as an early marker in the diagnosis of neonatal sepsis in University of Calabar Teaching Hospital, Calabar, Nigeria.Methods: This was a prospective case-control hospital-based study conducted from September, 2017 to April, 2018 among 60 neonates with suspected sepsis admitted into the newborn unit as well as healthy 60 age and sex-matched controls.Socio-demographic data, presenting complaints and risk factors for sepsis among others, were obtained using the pre-tested questionnaire.The history suggestive of sepsis included a history of prolonged rupture of membranes, peripartum pyrexia, prolonged labour, fever, fast breathing, convulsions among others.Physical examination was done with focus on signs suggestive of sepsis such as temperature instability, tachypnoea, dyspnoea, seizures, abdominal distension.Samples for procalcitonin test were collected along with samples for routine sepsis workup and blood smear for malaria parasite at presentation.Blood culture was done for anaerobic and aerobic organisms.The serum samples were pooled and analyzed for procalcitonin using quantitative ELISA test.Data was analyzed using SPSS version 20 and p< 0.05 was taken as statistically significant.Result: Out of the 60 subjects, 19 (31.7%) had blood culture positive sepsis, 36 (60.0%) had blood culture negative sepsis and 5 (8.3%) had neonatal malaria.The gram positive organisms accounted for 13 (68.4%) of the 19 bacteria isolated.Of the 36 neonates with blood culture negative sepsis, 31(86.1%)neonates had clinical signs and/or haematological parameters suggestive of sepsis.In addition, 3(8.3%) neonates had bronchopneumonia while 2(5.6%) had ophthalmia neonatorium.The median procalcitonin (PCT) level in the subjects compared with the controls was 0.98ng/ml and 0.40ng/ml respectively (p value = 0.000).The mean PCT level was 5.97±7.36ng/ml in the subjects and 1.58±3.64ng/ml in the controls.Among the subjects, the median PCT was 1.28ng/ml in blood culture negative sepsis and 0.93ng/ml in blood culture positive sepsis (p value = 0.000).In addition, the mean PCT level was also higher in neonates with blood culture negative sepsis (7.46 ± 8.07ng/ml) when compared with blood culture positive sepsis (4.60±5.99ng/ml).Based on the receiver operating characteristics curve, PCT levels ≥ 0.5ng/ml was suggestive of bacterial infection.Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve at PCT level of 0.5ng/ml were 68.4%, 29.3%, 30.0%, 66.7% and 0.51 respectively.Conclusion: These findings show that although serum PCT levels were higher in neonates with suspected sepsis when compared to the healthy babies, they were nevertheless lower in culture proven sepsis (septicaemia).PCT was insignificant as an acute phase reactant because of its low specificity and PPV in our environment.

Background: Quantitative urinary protein estimation is the cornerstone in the diagnosis, treatment and prognostication of renal diseases. This could either be carried out by 24-hour urine protein estimation or spot urine protein: creatinine (UPC) ratio. The latter is simple, convenient, quick and reliable. It can be used in the follow-up of asymptomatic proteinuric children at risk of developing chronic renal disease.Aim: To determine the prevalence of persistent proteinuria in asymptomatic primary school children in Calabar, Nigeria using the UPC ratio.Methodology: This was a descriptive cross-sectional study of 1,600 apparently healthy primary school children aged 5 to 12 years recruited by multi-stage sampling. Urinalysis using dipstick was performed and those with significant proteinuria (proteinuria ≥ 1+) had urinalysis repeated after two weeks. Those with persistent proteinuria were quantitated using the modified Biuret method while urine creatinine was measured with the modified Jaffe Kinetic method (done with the Biolabo creatinine kit). Urine protein:creatinine ratios > 0.20 were confirmed as persistent proteinuria.Results: Out of the 1,600 pupil, 761(47.6%) were males and 839(52.4%) females, giving a male to female ratio of 1:1.1. The mean age was 8.7 ± 1.9 ranging from 5-12 years.The modal age group was 9-10 years. The prevalence of persistent proteinuria using the dipstick urinalysis was 1.8% while with the UPC ratio was 1.6%. There was a high female preponderance 19 (1.2%) of persistent proteinuria, which was statistical significant. Age and social class did not contribute significantly to having persistent proteinuria.Conclusion: The prevalence of persistent proteinuria in these asymptomatic children using UPC ratio was almost similar to the repeat urinalysis done after two weeks. It is hereby recommended that where UPC ratio is not available a positive repeat urinalysis using first void early morning urine after two weeks can be used as persistent proteinuria. This information will enable proper treatment and follow-up which will forestall rapid progression to kidney damage.Keywords: Urinalysis,Protein: Creatinine Ratio,Asymptomatic Children.

The diagnosis of UTI is usually confirmed by microscopy and culture of properly collected urine specimens; however, due to scarce resources and other limitations, this is often not practicable in many resource poor nations. Since UTI if not identified early and treated could lead to serious complications, this study was therefore carried out to ascertain the clinical importance of Leukocyte esterase (LE) enzyme as a diagnostic tool for screening of Urinary Tract Infections (UTIs) in resource poor countries. The study was cross-sectional in nature comprising 250 asymptomatic pupils (120 males and 130 females) drawn from five nursery schools in Ikot Ansa in Calabar municipal area council in Nigeria. Subjects were selected using computer assisted random sampling methods. Urine specimens were collected, stored, transported, cultured and processed using standard laboratory procedures, while leukocyte esterase (LE) dipsticks were used as a screening tool for UTl and results compared with culture positive results. Significant bacteriuria through culture was recorded in 14 (5.6%) pupils and the commonest bacteria recovered were Escherichia coli 42.9% (6),Proteus mirabilis 21.5% (3) and Klebsiella pneumoniae 14.5% (2). Leukocyte esterase dipstick test correctly identified positive urine culture in 10 of 14 proven UTI (71.4%). The positive and negative predictive values were 25 and 98.1%, respectively. Leukocyte esterase test, though it has limitations in diagnosing UTI when compared to the culture methods, still proves useful in communities without facilities and requisite personnel for urine culture. The test is recommended for use in result limited communities, but where feasible, urine culture should be done. Key words: Children, leukocyte esterase, screening, urinary tract infection.

BACKGROUND:The complex of Down Syndrome-hypothyroidism-pericardial effusion is largely unreported in sub-Sahara.OBJECTIVE:To present and highlight an unusual manifestation of hypothyroidism.METHODS:A 16-year-old girl with confirmed Down Syndrome presented with complaints of generalised body swelling of eight months' duration. Her work-up consisted of full clinical and laboratory evaluation including ECG and echocardiography.RESULTS:The patient was diagnosed of Down's Syndrome at birth but was lost to follow-up after at eight years of age. Body swelling was associated with clinical features of heart failure. Echocardiography showed massive pericardial effusion. Serum l-thyroxine was less than 0.5mg/dl and TSH >40iu/l. The heart failure and menstrual irregularities responded to l-thyroxine therapy.CONCLUSION:This appears to be the first report of the complex of Down syndrome, hypothyroidism and pericardial effusion in a Nigerian child. Thyroid function test is therefore recommended as a part of baseline investigation for Nigerian children with Down syndrome as is the practice.

BACKGROUND Emerging data suggest that essential or primary hypertension occurs in the young. Parental socioeconomic status may play a role but the exact mechanisms still remain unclear. OBJECTIVE This study was aimed at determining the relationship between parental socioeconomic status and casual blood pressure in adolescents. METHODS One thousand and eight adolescents attending two secondary schools in Calabar, Nigeria were selected by stratified random sampling. Their blood pressure, weights and heights were taken using standard methods and sociodemographic data were obtained using a pretested semistructured questionnaire. RESULTS Blood pressure was increased with age with males having higher values. The other major determinants of blood pressure were weight, height, body mass index, level of physical activity and parental socioeconomic status (p <0.05). No relationship was established between these determinants as well as dietary habits with parental socioeconomic status (p > 0.05). Female adolescents with parents in the lower socioeconomic classes had significantly higher systolic and diastolic blood pressure (p < 0.05). In contrast, parental socioeconomic status showed no significant relationship with systolic blood pressure and diastolic blood pressure in males (p >0.05).The prevalence of elevated blood pressure was higher in females than in males. CONCLUSION Low parental socioeconomic status appear to be associated with higher casual blood pressure especially in female coastal Nigerian adolescents. Traditional determinants did not appear to play a significant role. Psychological stress arising from environmental and economic stressors may be responsible.

A retrospective study of children with acute glomerulonephritis (AGN) over a 10-year period (January 1997-December 2006) was carried out with the aim to establish the prevalence, the population at risk, and the predisposing factors. Out of a total of 6,026 admissions during the study period, 76 (1.3%) had acute glomerulonephritis. Forty of the 76 were males while 28 were females with a male to female ratio of 1.4:1. The mean age for males was 7.2±4.3 years and that of females was 6.5±3.2 years. The overall age range was 3-13 years with a modal age of 5 years for both sexes. The annual prevalence showed two peaks, May-July and October-January. Eighty two percent of patients were of the low while 11.8% were of the middle socioeconomic classes. Haematuria, oedema, proteinuria and hypertension were the major presenting features. Hypertensive encephalopathy and acute renal failure were the complications recorded and also emerged as the causes of death. Childhood AGN is common in Calabar compared to other centres in Nigeria, afflicting largely those of low socio-economic status and displays a peak in the middle of both dry and rainy seasons of the year. The outcome is good but could be better if facilities are provided for dialysis.Key words: Glomerulonephritis, prevalence, children, patients

SUMMARY We studied the prevalence of congenital malaria among neonates with suspected sepsis and its outcome at the University of Calabar Teaching Hospital, Calabar, Nigeria. All in-born neonates admitted to the newborn unit with clinical features suggestive of sepsis were recruited. They were screened for bacterial sepsis and malaria. The mothers of the neonates that had parasitaemia were further screened for malaria and anaemia. A total of 546 in-born neonates were admitted to the neonatal unit and 202 (37%) presented with clinical signs suggested of sepsis. Of these, 71 babies (35% of 202 or 13% of the total in-born nursery admissions) had congenital malaria and 14 also had sepsis. Sixty-three (88.7%) of the parasitaemic babies were delivered by mothers who received antenatal care at our centre. Eighty-six percent of the mothers of the 71 babies also had the malaria parasite in their blood. The majority (67%) of the 71 mothers were gravidae 2 and below. Thirty (42.3%) of the affected neonates were anaemic and 5 (7%) of them required a blood transfusion. Congenital malarial is not uncommon in Calabar among babies with suspected sepsis. It appears that the antenatal chemoprophylaxis with pyrimethamine (25 mg weekly) currently used for malaria in our centre no longer protects the mother and fetus. An alternative is needed in order to stem maternal, fetal and neonatal morbidity and wastage. Babies with features of sepsis should be routinely screened for malaria.

BACKGROUND:The morbidity and mortality pattern amongst neonates admitted into the University of Calabar Teaching Hospital were reviewed from 1st June 2003 to 30th November 2004.RESULTS:The major indications for admission for inborn babies were infections (27.4%), jaundice (21%) and low birth weight (LBW) (18.4%). The out born babies were admitted largely for sepsis (26.8%), jaundice (17.7%), tetanus (13.9%) and low birth weight (11.2%). Staphylococcus aureus (61.2%) and unclassified coliforms (21.9%) were the dominant isolates of septicaemia. The overall mortality rate of 19.3% was largely contributed by outborn infants (73.2% of the deaths). In descending order of magnitude, the total of 153 deaths during the period was due to infections (neonatal tetanus 20.9%, septicaemia 19.6%), birth asphyxia 23.3% and LBW 19%. Most of the deaths (70.6%) occurred within the first 7 days of life. Fifty-three (34.6%) of the deaths (most outborn infants) occurred within 24 hours of admission.CONCLUSION:Nigerian government needs to improve funding of the health sector in order to reduce neonatal wastage. Training and retraining of traditional birth attendants is inevitable. More effort should be made towards improving coverage rate of tetanus toxoid among women of childbearing age.

OBJECTIVE:To determine the involvement of medical practitioners working in a tropical setting in the treatment of their relatives.DESIGN:Cross-sectional.SUBJECTS:Medical practitioners of all cadres working in the University of Calabar Teaching Hospital, Calabar, Nigeria.SETTING:A large teaching hospital in Calabar, Nigeria. A referral centre for two states.MAIN OUTCOME MEASURES:Extent, type and effect of involvement in the practice.RESULTS:Majority (90.9%) of medical practitioners in our centre were found to have been involved in the treatment of their relatives. Services rendered included consultation, in which all respondents (100%) have partaken. Cardiopulmonary resuscitation (16.9%) and emergency surgery were performed by only a few (3.1%). Though fees were not charged for services provided by most; a few (13.1%) did so. Outcome of involvement was unfavourable in some instances: 9.4% lost relatives they were involved in treating. Majority of the respondents 51.7% believed it is unethical to treat relatives and advocated for only limited involvement. This is because the pressure from relatives for care cannot be entirely ignored.CONCLUSION:It is difficult in our environment not to accede to request to treat family members. We recommend that practitioners may offer only consultation, and in some cases treat minor ailments while referring more serious ones to appropriate colleagues.

SUMMARY A three-year survey of neonatal septicaemia (363 bacteriologically proven cases) in the University of Calabar Teaching Hospital, Calabar, has demonstrated that the dominant blood isolate was Staphylococcus aureus (53%) followed by unclassified Coliforms (20%), an unexpected Chromobacterium violaceum (5%). The incidence of neonatal septicaemia was 54.9 per 1000 live births for inborn infants. The predominant organisms were largely susceptible to gentamicin, ceftriazone and cefuroxime with a mortality rate of 19% with most (60.9%) of the fatalities being due to Gram-negative organisms.

BACKGROUND:Worm infection and anaemia are common childhood conditions in Nigeria. We assessed the status of helminthiasis and associated anaemia among pre school children of peasant farmers aged 1-5 years living in a rubber plantation near Calabar, Nigeria.DESIGN:Cross sectional.METHOD:Three hundred and fifty children were selected by multi-stage cluster sampling technique. Freshly passed stool was examined using Kato-Katz method while anaemia was estimated using haematocrit technique.RESULT:Of the 350 children, 174 (49.7%) had intestinal helminths: Ascaris lumbricoides 64.4%, hookworms 10.9% and Trichuris trichuria 1.1%. There were 41(23.6%) children with polyparasitism, 33 of them were due to Ascaris lumbricoides and hookworms. The worm load was generally light in intensity with egg per gram of stool ranging from 24-60,960. Males (28.9%) were infected more than females (20.8%). The frequency of infection increases with age. The prevalence of anaemia among the entire study population and in those infected with worms was 56.6% and 56.9% respectively. With polyparasitism there was a relative increase in the frequency of anaemia females > males.CONCLUSION:Worm infections and anaemia are common in our children. A comprehensive control strategy involving good sanitation, sinking of bore hole for clean water supply and regular deworming exercises are recommended.

A 10-year retrospective review of inpatients in Calabar showed that of 5641 children admitted,182 (3.2%) had renal disease. The major lesions were acute glomerulonephritis (36.9%) and nephrotic syndrome (30.7%), while less common ones included urinary tract infection (8.9%), obstructive uropathy, acute renal failure (6.7%, each) and nephroblastoma (6.2%).

OBJECTIVE:To assess the occupational risk of infection by human immunodeficiency virus (HIV) as well as hepatitis B virus (HBV) among healthcare workers in south-eastern Nigeria.DESIGN:Cross-sectional study.SETTING:Three tertiary health institutions in south-eastern Nigeria.SUBJECTS:Doctors, nurses, laboratory staff and cleaners.MAIN OUTCOME MEASURES:Observation of the availability and use of protective equipment and materials in the various departments of the hospitals.RESULTS:Materials and equipments needed for protective and hygienic practices (adequate water supply, protective clothing and availability of disinfectants) were inadequate in all hospitals. Where available, they were found to be inconsistently used. Health workers in the three institutions were thus constantly exposed unnecessarily to blood and other body fluids which might be potentially infectious as well as injury from used sharps.CONCLUSION:The risk of acquiring HIV and HBV infections by health workers in this region of Nigeria in the course of performing their duties is therefore still apparently high. Though distinct viruses, they share similar mode of transmission and risk factors. Use of personal protective equipment and adoption of standard hygienic practices among health workers must be encouraged. Supply of protective materials and equipment should be greatly improved. It is recommended that reduction of occupational risks among health workers using this approach should form part of control strategies for both infections in the country.

This cross-sectional anthropometric study involved one thousand and five randomly selected children and adolescents aged 6 to 18 years resident in Calabar, Nigeria. It was aimed at determining the profile of Body Mass Index (BMI) as well as the prevalence of obesity in the group. Subjects had their heights and weights measured using standard methods and Body Mass Index calculated. Those with BMI of 95th percentile for their ages and sexes were considered obese. Body Mass Index as well as other anthropometric parameters were found to increase progressively with age with females having higher values. The prevalence of obesity in 6-12 years old children was 2.3%. Adolescents 13-15 years had a prevalence of 4.0% while those 16-18 years had 3.0%. Though females had a higher prevalence in both groups, the difference was not statistically significant (l2 = 4.90 df = 2, P > 0.5) We conclude that obesity hitherto seen predominantly in developed countries is a potential health problem in developing countries despite the prevailing poor socioeconomic situation. The significant role played by factors other than the environment in the development of obesity has since been recognised. Since treatment of adult obesity is largely difficult, the need for intervention during childhood and adolescence which includes early detection and prevention cannot be overemphasized.